Reforming central hospitals for effective service delivery

MHANGO—Major steps have been made

At the height of the reforms in the operations of central hospitals in Malawi were efforts to turn the health facilities into public trusts.

It has been years since the journey started to reform the health facilities but now the excursion seems to have reached the final stages according to officials.

The exercise is part of the Health Sector Strategic Plan, which demonstrated the Government of Malawi’s political commitment to health sector reform.


The new order of doing things would see Kamuzu Central Hospital in Lilongwe, Mzuzu Central Hospital, Zomba Central Hospital and Queen Elizabeth Central Hospital in Blantyre being run as independent entities by a board of trustees.

Ministry of Health would retain its oversight role and mandate to ensure the facilities and those who will be running them adhere to government policies.

The appointed board of trustees would also be responsible for the implementation of day-to-day activities in the referral hospitals which have been critical in the provision of advanced healthcare services to Malawians despite several challenges.


But the notion that the boards would also be responsible for the management of resources in the facilities has raised fears that the central hospitals could be run as private entities if the board sees it fit to introduce user fees as one way of generating funds.

This, officials say, is far from the truth.

Confirming that the government has made headway with the reforms, Ministry of Health spokesperson Adrian Chikumbe said the reforms are in the best interest of Malawians.

“We believe that central hospital autonomy will enhance the ability of both operational and strategic management of the hospitals to be able to respond quickly to their service delivery needs apart from improving accountability and transparency in the management of financial and human resources,” Chikumbe says.

He adds that once the central hospitals have autonomy, referrals abroad will be minimised.

“The improved efficiency of, access to, and quality of hospital care are then expected to lead to better health outcomes for the clients of these institutions, better client satisfaction and improved financial risk protection, especially for the poor,” Chikumbe says.

Chikumbe also argues that managers and their boards will be able to plan properly on how they want to deliver quality healthcare services and they will be able to deliver on those plans unconstrained by the central government.

Health rights activist Maziko Matemba has described the development as long overdue.

Matemba backs the government’s stand that giving autonomy to central hospitals will enhance efficiency in the health facilities.

Like Chikumbe, Matemba believes the reforms will enhance transparency and accountability in the way central hospitals have been operating in the country.

“The reforms are important because now we will know who is responsible for what. For a long time now, there have been blame games between headquarters [Ministry of Health] and the facilities whenever there is a hitch in service delivery but now with such reforms, there will be accountability as all decisions will be made by managements at the facilities,” Matemba says.

However, he warns that government should ensure that it conforms to the tenets of Universal Health Coverage (UHC) as it implements the reforms.

Matemba also calls on the government to extend the reforms to district hospitals in the soonest time possible, saying there is need to define the roles of various health institutions in the provision of health services.

“In recent times, we have seen central hospitals treating basic illnesses such as mere coughs, skin diseases and malaria, when they are supposed to be referral facilities, so we are hoping that these reforms will define the roles various institutions have to play. We need to know the role of district hospitals, community hospitals and indeed central hospitals.

“Suffice to say that, as we implement the reforms, we should not ignore the concept of UHC where all people, regardless of where they are coming from, have access to quality health care,” Matemba says.

The reforms, once finalised, will be similar to what happened to Central Medical Stores Trust.

“After a successful hospital reform, the semi-autonomous status of central hospitals will improve planning, increase ownership and accountability at hospital management level and improve service delivery,” says Themba Mhango, a technical expert on the matter.

Mhango is among members of a team of experts at German International Cooperation (GIZ) which has helped Malawi’s effort to support reforms in the central hospitals.

He says the reforms will enhance the efficiency of the central hospitals as decisions regarding operations, recruitment and financial management will be made right at the facilities.

Mhango says, currently, GIZ is working with Ministry of Health to build the capacity of the targeted central hospitals.

“Major steps have been made so far to the extent that Trust deeds have been developed; human resource management based on performance has been prepared; management has been trained in public finance management and outsourcing of non-core services and strategic plans for central hospitals have been developed,” he explains.

Making central hospitals autonomous is now a policy of Malawi Government after Cabinet approved the proposal in February, 2018.

Ministry of Health has already communicated with stakeholders on potential names for the central hospital boards.

Various stakeholders, including institutions of higher learning, Medical Council of Malawi, Malawi Law Society and Council for Non-Governmental Organisations are being consulted as government moves closer to having standalone referral hospitals.

Other African countries, including Ghana, already reformed all their hospitals.

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